Prospects for eliminating racial differences in breast cancer survival rates.

Abstract

Results from the randomized trial underway in the Health Insurance Plan of Greater New York to determine the efficacy of periodic screening with mammography and palpation of the breast have been examined to determine the effect of screening on racial differences in breast cancer survival rates. Consistent with experience in general populations, the control group showed a lower five-year survival rate among non-White women with breast cancer than among White women. In the study group, 65 per centIn this paper, information from the randomized control trial to test the efficacy of screening for breast cancer* being conducted by the Health Insurance Plan of Greater New York (HIP) is utilized to examine differentials in survival rates among non-White women compared with White following diagnosis of breast cancer.Briefly, the situation in the general population is that Black women with breast cancer have a markedly poorer fiveyear relative survival rate** from breast cancer than White women as exemplified in Several explanations might be advanced for the relatively poor survival rates from breast cancer among Black women: e.g., differentials in diagnostic delay because of variations in recognition of signs and symptoms and care seeking behavior; quality of care; or the underlying biological course of breast cancer due to genetic or other host factors. Results from the HIP study discussed below suggest that secondary prevention programs may be an effective approach to changing the poor survival rate of Blacks. The HIP StudyThe HIP study's design, methodology, and findings for all races combined have been reported extensively in the literature.4 The investigation was initiated toward the end of 1%3 to determine whether periodic screening with clinical examination and mammography results in reduced breast cancer mortality among women aged 40-64 years at time of entry. Women in this age group who were members of the Plan, a comprehensive prepaid group practice with a wide spectrum of socioeconomic groups of enrollees, were allocated through a stratified random procedure to study and control groups, each consisting of 31,000 individuals. Study women were offered screening examinations; the 65 per cent who appeared for the initial examination were offered three additional examinations at annual intervals unless earlier follow-up or biopsy was indicated; all but a small proportion (12 per cent) had at least one additional annual examination. Control women received their usual medical care which during the 1960s did not emphasize other early detection methods, e.g., breast self-examination.Screening ended in 1970 and follow-up of the tested cohorts of the study and control women, including those who are no longer enrolled in HIP, has continued to date to

Race and mammography use in two North Carolina counties.

“…[2][3][4][5][6][7] In the Black/White Cancer Survival Study, later stage at diagnosis for Black women accounted for a substantial proportion of the racial difference in survival, and among Black women later stage at diagnosis was associated with lack of mammography.6'7 Data from the Health Insurance Plan study suggested that screening Black and White women at equally intensive rates probably would reduce racial differences in breast cancer survival. 8 Although evidence conflicts, racial differences in mammography use probably persist, especially among special populations such as older, poorer, and rural women. 9 Race and Maammography Use age with no personal history of breast cancer.…”

Breast cancer screening: its impact on clinical medicine

“…Favourable effects outweigh the inevitable unfavourable effects, with high quality screening and an appropriate invitation system. Breast cancer screening can also be recommended after considering other consequences than mortality reduction.Several trials have shown that mammographic screening of post-menopausal women reduces breast cancer mortality (Shapiro et al, 1982;Verbeek et al, 1984;Collette et al, 1984;Tabar et al, 1985;UK Trial 1988;Andersson et al, 1988). The introduction of a national programme in the United Kingdom, offering tri-annual screening to women aged 50-65, would result in a mortality reduction of 8% (Knox, 1988).…”

Jones BA, Patterson EA, Calvocoressi L. Mammography screening in African American women: evaluating the research. Cancer. (2003) 97(1 Suppl):258–272.

“…To our knowledge, among the eight randomized clinical trials that have evaluated screening mammography, [11][12][13][14][15][16][17][18][19][20] only the Health Insurance Plan of Greater New York (HIP) Study 11 included a substantial proportion (approximately 20%) of black participants and provided race-specific results. 21,22 In a single report of race-specific survival rates, Shapiro et al showed that substantially more white than black women in the control group survived breast cancer five years from diagnosis (60.9 % versus 47.1 %). In contrast, very similar five year survival rates were observed (73.4 % and 76.6 %, respectively) among whites and blacks in the group that was offered mammography screening.…”

“…These included: 1) very low statistical power to show a race difference in survival in the study group, due to the small sample of nonwhite breast cancer cases and 2) a lower proportion among nonwhite subjects of axiliary nodal involvement in the study group as compared with the control group. 22 …”